Medication administration system

ABSTRACT

The present invention comprises a system and method for administering medications to a plurality of patients in a medication institution. A preferred system comprises a workflow program for generating a scheduler, wherein the scheduler coordinates the administration of medications to the patients, a medicine cabinet, responsive to said scheduler, for storing medications and dispensing the medications to an authorized user for administration to the patients, the workflow program providing the cabinet with patient specific information relating to said dispensation of the medications including a physician order for each patient, and a medicine cart, coupled to the medicine cabinet, for instructing said authorized user in the administration of said medication to each of said patients. The cart comprises a plurality of patient specific cart drawers for storing the medication to be administered to each patient, wherein each cart drawer remains unidentified as patient specific until the medication cart receives said patient specific information, and a cart processor, wherein the cart drawers are filled with medicine from the medicine cabinet for each patient associated with each patient specific cart drawer in accordance with the respective physician order for each patient.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a continuation in part of U.S. patent applicationSer. No. 09/706,872 filed Nov. 7, 2000; and PCT Patent Application No.PCT/IL01/01030 filed Nov. 6, 2001, which are each herein incorporated inits entirety, and further claims all priorities accorded PCT ApplicationNo. ______ filed herewith.

BACKGROUND OF THE INVENTION

The present invention relates to medication administration systems. Morespecifically, the present invention relates to medication administrationsystems in a medical facility.

Automated medication dispensing systems have been in use for many years.The initial purpose of such systems was to reduce the high rates ofmedication errors associated with manual distribution and the high costof maintaining a large amount of inventory. The literature indicatesthat medication errors occur in the following areas: 13% at prescribing,42% at administering, 27% at documentation, 17% at dispensing and 1% atmonitoring (Summary of Information Submitted to MEDMARX™ in the Year2000). The current automated systems present more sophisticatedadvantages, including: lower costs associated with pharmaceuticaldistribution, reduction of personnel, inventory control, substancecontrol, automated documentation, further reduction of errors, andrelieving professional pharmacists and nursing personnel of many tasks.

There are two types of methods and currently two ways of dispensingmedications employed in medical facilities: centralized systems, anddecentralized systems.

The centralized systems are based on the transfer of the physician'sorders/prescription to the central pharmacy of the medical facility.These systems facilitate the transfer of orders/prescriptions to thecentral pharmacy after being reviewed by personnel in the ward/floor,whereupon the orders/prescriptions are reviewed, authorized and filledby a pharmacist, sent as a unit dose to the ward, where every patienthas a personal container, usually at a central location, that containsall his medicine for the next 24 hours, and then dispensed to theappropriate patient according to each individual hospital's routines.Centralized systems are used primarily in the U.S.A. They are costly andvery inefficient, mainly because of the use of a large trained staff.

Decentralized systems are based on ward stocks managed by trainednursing personnel in conjunction with pharmacists from the hospitalpharmacy. The dispensing procedure traditionally proceeds as follows:

The nurse receives from the physician the prescription/s stating themedication, time of delivery, and route (p.o., I.V., etc.).

At the appropriate time, the nurse retrieves the appropriatemedication/s for the patients according to a list of orders, places themedications into a receptacle, usually with an attachment that indicatesthe patient's name, places the receptacles on a tray, and then dispensesthe receptacles to the patients in the ward.

The foregoing traditional method is subject to a number of disadvantagesincluding: (1) possible confusion between patient files; (2) errors inbrand or dosage when retrieving medications from the medicine cabinet;(3) errors in identifying individual patients; (4) errors in receptacleidentification; (5) a demand on much of the nurse's time; (6)possibility of mistakes in inventory record keeping and pharmacyordering; and (7) very low degree of control, even though expensiveand/or narcotic drugs are involved.

A report from the Institute of Medicine (IOM) of the National Academiesreleased in November 1999 in the U.S.A. calls on Congress to create anational patient safety center to develop new tools and systems, thereason being alarming figures regarding the human cost of medicalerrors. Deaths from medical errors are estimated, according to differentstudies, to be between 44,000 to 98,000 people in the U.S. hospitalseach year, which is more than those from highway accidents, breastcancer or AIDS. The report states that illegible handwriting, and thenon-coordinated treatment of patients by several practitioners who donot have complete information about the medicines prescribed and thepatient's illnesses, are part of the basic flaws in the way the healthsystem is presently organized. William Richardson, chairman of thecommittee, is quoted as saying “It may be part of human nature to err,but it is also part of human nature to create solutions, find betteralternatives, and meet the challenges ahead.”

Medication management devices generally fall under three categories: (a)automated devices in the central pharmacy area; (b) automated devices inthe patient care unit; and (c) point-of-care information systems.

The primary goal of using centrally-located devices is to replace orimprove the current manual process for filling unit dose containers.These devices offer the advantage of a lower, single, centralizedinventory. Disadvantages of such devices include large size, high cost,and reliance on efficient delivery systems from the central pharmacy.

Many systems have been proposed and are described in the literature forminimizing or eliminating the above-described disadvantages of theexisting systems. Examples of such recent developments are described inU.S. Pat. Nos. 6,032,155; 6,021,392; 5,912,818; 5,314,243; 5,564,803;6,003,006; 6,068,156; 5,842,976; 5,797,515; 5,014,875; 5,460,294; and5,713,485.

However, prior to the present invention there has been a very pressingneed to provide a flexible medication dispensing system which utilizesboth the centralized and decentralized methods of dispensing medication,and meets at least the following goals: (1) provides secure and reliablemedication dispensing; (2) permits more efficient workflow; (3) allowsfor the collection of vital signs (e.g., temperature, pulse rate andblood pressure); (4) maximizes automation and employs computerizedpaperless operation; (5) automates management of drug inventory in eachdepartment; (6) protects against “drug abuse” by medical andpara-medical personnel; and (7) offers special protection for narcoticdrugs.

SUMMARY OF THE INVENTION

An object of the present invention is to provide a medication dispensingsystem, and also a medicine cabinet structure and enabling attaining oneor more of the foregoing goals.

Accordingly, the present invention comprises a system and method foradministering medications to a plurality of patients in a medicationinstitution. A preferred system comprises a workflow program forgenerating a scheduler, wherein the scheduler coordinates theadministration of medications to the patients, a medicine cabinet,responsive to said scheduler, for storing medications and dispensing themedications to an authorized user for administration to the patients,the workflow program providing the cabinet with patient specificinformation relating to said dispensation of the medications including aphysician order for each patient, and a medicine cart, coupled to themedicine cabinet, for instructing said authorized user in theadministration of said medication to each of said patients. The cartcomprises a plurality of patient specific cart drawers for storing themedication to be administered to each patient, wherein each cart drawerremains unidentified as patient specific until the medication cartreceives said patient specific information, and a cart processor,wherein the cart drawers are filled with medicine from the medicinecabinet for each patient associated with each patient specific cartdrawer in accordance with the respective physician order for eachpatient.

BRIEF DESCRIPTION OF THE DRAWING

The invention is herein described, by way of example only, withreference to the accompanying drawings. With specific reference now tothe drawings in detail, it is stressed that the particulars shown are byway of example and for purposes of illustrative discussion of thepreferred embodiments of the present invention only, and are presentedin the cause of providing what is believed to be the most useful andreadily understood description of the principles and conceptual aspectsof the invention. In this regard, no attempt is made to show structuraldetails of the invention in more detail than is necessary for afundamental understanding of the invention, the description taken withthe drawings making apparent to those skilled in the art how the severalforms of the invention may be embodied in practice.

FIG. 1 is a block diagram illustrating the various components of apreferred embodiment of a medication dispensing system constructed inaccordance with the present invention.

FIG. 2 is a block diagram illustrating the central (or ward) computer inaccordance with the preferred system of FIG. 1.

FIG. 3 is a diagram more particularly illustrating an exemplary form ofa medicine cabinet in accordance with the preferred system of FIG. 1.

FIG. 4 is a diagram of a lock and spring mechanism in accordance withthe preferred embodiment of the present invention.

FIG. 5 is a diagram illustrating the construction of the mobile cart inthe system of FIG. 1.

FIG. 6 is a diagram more particularly illustrating the portable computerfor the physician and/or pharmacist in the system of FIG. 1.

FIGS. 7 is an exemplary illustration of a frame of the prescriptionprogram which allows a physician to input his/her authorizationinformation in accordance with a preferred embodiment of the presentinvention.

FIG. 8 is an exemplary frame of the prescription program whichillustrates a list of patients in accordance with a preferredembodiment.

FIG. 9 is an exemplary frame of the prescription program which is agraphical illustration of the vital signs of a patient in accordancewith a preferred embodiment.

FIG. 10 is an exemplary frame of the prescription program which is atabular illustration of the vital signs of a patient in accordance witha preferred embodiment.

FIG. 11 is an exemplary illustration of a frame of the prescriptionprogram which allows a physician to review a patient's prescriptions inaccordance with a preferred embodiment.

FIG. 12 is an exemplary illustration of a frame of the prescriptionprogram which allows a physician to add new medications to a patient'sprescription in accordance with a preferred embodiment.

FIG. 13 is an exemplary illustration of a frame of the prescriptionprogram which displays details of a newly prescribed medication inaccordance with a preferred embodiment.

FIG. 14 is an exemplary illustration of a frame of the prescriptionprogram in accordance with a preferred embodiment.

FIG. 15 is an exemplary illustration of a medication preparation frameof the cabinet program in accordance with a preferred embodiment.

FIG. 16 is an exemplary frame of the cabinet program which displays apatient's name, ID and medications to be administered.

FIG. 17 is an exemplary frame of the cabinet program which illustratesinstructions for dispensing medications from the cabinet.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

The Overall System

A preferred embodiment of the present invention will be described inrelation to the drawing figures wherein like numerals represent likecomponents throughout.

FIG. 1 is a block diagram illustrating the main components of apreferred embodiment of a medication dispensing system 10 constructed inaccordance with the present invention as may be provided in a medicalinstitution having one or more wards. The illustrated system includes acentral server, generally designated 20, one or more work station(s) 70for each ward; one or more medicine cabinets to serve one or more wards,generally designated 30, and one or more medication carts, generallydesignated 50. Each medication cart 50 is preferably adapted toaccommodate a plurality of compartments, generally designated 51, 52,one or more for each patient in the respective ward and/or medication.System 10 further includes a plurality of hand-held, portable computers,each generally designated 60, for use by physicians, authorizedpersonnel and/or pharmacists, when writing and/or authorizingprescriptions for individual patients.

As will be described more particularly below, a preferred systemcomprises server 20, medicine cabinet 30, cart 50, work station 70, andhand-held POE computer 60 enable information involved in the dispensing,replenishing and record-keeping operations to be performedelectronically without requiring the attendant medical personnel toaccess to patient's written files. Such a system therefore minimizes thepossibility of error, and also relieves the nurses or other healthcareattendants of many tasks required in the conventional medicationdispensing system. In addition, described system 10 enables thehealthcare attendants to enter vital signs of the patient into therecords in order to provide updated information of the patient's medicalcondition.

Central Server

Central Server 20, provided in a medical institution, is coupled tomedicine cabinet 30 and workstation 70 and comprises a database 22 and aserver processor 23. It should be noted that a “medical institution,” asdefined herein, includes elderly homes, hospitals and overnight medicalfacilities or clinics of all sizes, which administer medicationson-site, such as those facilities having only a few beds, as well ashospitals having one or more wards, each ward having a plurality ofbeds. “Ward” is generically defined herein and means an institution oran area of an institution that is named for the type of patients thatare admitted therein, for example, the maternity ward, cardiology wardand the like. Server 20 may also be coupled to a pharmacy computer andan institution's legacy system, such as a hospital information system(HIS), each to be disclosed below. It is known that an institution'slegacy system includes patient information from institution labs, anAdmission Dismissal Transfer (ADT) database, and the like.

Server processor 23, coupled to database 22, executes a server softwareprogram, which stores and transfers an electronic record of a pluralityof predetermined events and automatically transmits and synchronizessystem 10 and its components, (comprising cabinet 30, cart 50, one ormore work station(s) 70 and one or more POE computer(s) 60). Events, asdisclosed herein, refer to any action conducted by an authorizedphysician or healthcare attendant at a medical institution. Serverprocessor 23 also transfers data transmitted from and data to betransmitted to medicine cabinet 30, the institution legacy system and/orthe pharmacy computer between system 10 components, as will be disclosedin greater detail below.

Although, server 20 is preferably separate from other components, thefunctionality of server 20 may reside on a workstation 70. Workstation70 will be disclosed in greater detail below. Also, although server 20is shown to be coupled to cabinet 30 and workstation 70, in analternative embodiment, server 20 may communicate with all systemcomponents through a wire connection or wireless RF or IR connection.

Medicine cabinet

As disclosed above, server 20 is coupled to medicine cabinet 30 and workstation 70. Information received by, and stored on, server 20 istransmitted to medicine cabinet 30 through a communication link 36included in medicine cabinet 30. Medicine cabinet 30 is coupled toserver 20 and medicine cart 50 and comprises the communication link 36,a control unit 33, which includes a cabinet processor 38 for accessing acabinet program that operates cabinet 30, and a plurality ofcompartments 31 for storing, for example, supplies of the differentkinds of medications to be accessed by a healthcare attendant, which areused for preparing individual dosages to be delivered to the respectivepatients. Medicine cabinet 30 further acts as a communication linkbetween cart 50 and server 20 for recording information in server 20,e.g., vital signs of the respective patients as may be taken duringrounds, as well as other information, as will be disclosed in greaterdetail below.

In a preferred embodiment of medicine cabinet 30, as shown in FIG. 3,cabinet 30 comprises a housing in which the medication compartments arein the form of drawers 31 arranged in an array 130, referred to hereinas a frame, preferably comprising one or more horizontal rows andvertical columns. As shown, the housing is rectangular, and drawers 31are arranged in a rectangular frame 130. However, medicine cabinet 30need not be limited to a specific size or shape.

Each frame 130 is preferably organized according to different drawersizes. It should be noted that drawers 31 of medicine cabinet 30 may beeither medication-specific, patient-specific or a combination ofmedication and patient-specific. Those drawers 31 that are patientspecific each comprise a display, such as an LCD display that displaysthe name of the patient assigned to the drawer 31. Each medication andpatient specific drawer 31 also preferably includes a lock mechanism(not shown), which normally locks the drawer in its closed position, butwhich is selectively actuatable to unlock and spring forward the drawerto enable a pre-authorized healthcare attendant to access the medicationsupply within the drawer. An exemplary lock mechanism is illustrated inFIG. 4, but other such mechanisms would be known to one skilled in theart.

As shown in FIG. 4, each lock and spring mechanism for each drawer 31 isactivated by an “open” signal from the cabinet's processor 38, as willbe disclosed in additional detail below. When the lock mechanismreceives the “open” signal from processor 38, the lock mechanism springsdrawer 31 forward, exposing the medication stored therein to thehealthcare attendant who has opened the drawer.

As shown, the exemplified lock mechanism comprises a solenoid coil 323,a solenoid 324, a solenoid cylinder 325, a snapper 326, and a mainspring329. However, any of a variety of lock mechanisms known to one ofordinary skill in the art may be used to maintain drawer security andoperation as exemplified herein.

As shown in FIG. 4, exemplified cabinet drawer 31 comprises a drawerquick release mechanism 310 and a linear slide bearing 320. Inoperation, cabinet process 38 initiates an open signal and switches on aDC voltage supply (not shown) of 9-11 volts on solenoid 324. Solenoid324 then applies a magnetic field on solenoid coil 324, which results inthe movement of solenoid coil linearly upward. As solenoid coil 324moves upward, solenoid cylinder 325 is pulled upward, releasing snapper326.

Once snapper 326 is released, mainspring 329 springs drawer 31 forward.Drawer 31 is then opened allowing medication therein to be dispensed ormedication to be placed therein, as will be disclosed in greater detailbelow.

After the medication is taken out of or placed into drawer 31 asrequired, drawer 31 is preferably pushed back to the closed position. Asdrawer 31 is being pushed back, snapper 326 is pushed against solenoidcylinder 325, which is being pushed up. Once the snapper clears solenoidcylinder 325, solenoid coil 324 pushes solenoid cylinder 325 downward,locking drawer 31 in its original locked position, whereupon snapper 326is held in place by solenoid cylinder 325.

Referring back to FIG. 3, the exemplified and illustrated medicinecabinet 30 further comprises an integrated touch screen 34 coupled tocontrol unit 33, a communication link 36 for linking to central server20, and communication link 37 for linking to one or more cart(s) 50.Such communication links 36, 37 are schematically shown as connectorsfor wired communication, but could also be transmitters and receivers(e.g., RF, IR, acoustical) for wireless communication as would berecognized by one of ordinary skill in communication technologies. Inaddition to the data that is input via the communication links 36, 37,data is inputted manually via a virtual keyboard included in touchscreen 34. Communication link 36 is a direct connection to server 20 andallows medicine cabinet 30 to interface with the database 22 on server20, for real-time updates. It also facilitates providing necessaryinformation to guide the pre-authorized healthcare attendant in thepreparation of patient medications, intravenous solutions and the like,to be disclosed hereinafter. In an alternative embodiment, an actualkeyboard or keypad may replace the functions of touch screen 34.

Information sent to and received from medicine cabinet 30 by server 20is processed by server processor 23. In one preferred embodiment, thecabinet program is not directly compatible with database 22.Accordingly, server processor 23 preferably converts the information toa usable format for database 22 when transmitted from cabinet 30 and toa usable format when transmitted to cabinet 30. In another embodiment,the cabinet program is directly compatible with database 22, whereinserver processor 23 stores the information until transmitted by cabinet30 or database 22.

The foregoing components of medicine cabinet 30, illustrated in FIG. 3,are electrically powered, e.g., by a power supply, which preferably alsoincludes a back-up unit in the event of power interruption or failure.

Such a cabinet 30 has a capability of accommodating a large number ofdifferent medications, although not all drawers or compartments 31 mustbe used at any point in time. If needed, however, a ward may be providedwith more than one frame 130. Such an additional frame or frames 130 awould provide additional drawers 31, but would include a cableconnection to control unit 33 of cabinet 30 in order to enable eachadditional frame 130 a to share its display 34.

It should be noted that the sections of the medicine cabinet configuredfor “special” medications, e.g., those medications too large for themedication or patient specific drawers, those requiring storage at aspecial temperature, and/or special protective measures to controlaccess (IV fluids, refrigerated medicines, narcotics, etc.) may beprovided in an additional frame 130 a. In a preferred embodiment, frame130 a is specifically configured to support the “special” medications.For example, a frame 130 a for medicine cabinet 30 may be configured toprovide for the storage of “special” medications, along with the“non-special” medications. Where cooling is required, frame 130 aincludes one or more refrigeration unit(s). Where special securitymeasures are required, such as for narcotics, a secure section of thearray is secured by an additional locking system. For example, it may beunlocked only when a proper identification means, such as a validpassword, a biometric identification or a personal identification isinputted using the touch screen 34 or keypad.

Although, the storage of “special ” medications has been disclosed asbeing handled by an additional frame, storage may in the alternative beprovided in frame 130 which may include a section(s) for storage of suchspecial medications, or by other arrangements linked thereto. It ispreferable, though, that refrigerated medications and narcotics residein separate frames.

During a system failure only, an electronic backup system may beoperated to open all the drawers 31 in cabinet 30, which then, in fact,transforms cabinet 30 into a completely manual cabinet. The backupoperation is initiated, for example, by pressing a covered push button(not shown), which opens all the drawers 31 of a given frame 130.Preferably, access to the button is simple, with each frame 130 having asliding cover that when open, unveils the push button. In an alternativeembodiment, access to the button will be accessible only by a key orother manual unlocking mechanism.

In the event of an electrical system failure, system 10 will be backedup by a UPS system for several hours, which is very unlikely in patientcare settings. If no electricity is available, the back of each frame130 may be opened, and the drawers 31 released manually by a procedurethat involves the release of a latch mechanism on each drawer 31, drawerby drawer, after which operation of the cabinet is completely manual.

In a centralized system, medicine cabinet 30 may alternatively belocated in the central pharmacy, wherein all medications inventoried inthe medical institution are stored. In this alternative embodiment,medicine cabinet 30 would operate in the same manner as disclosed abovein the preferred embodiment and comprise a plurality of frames 130, 130a.

Although cabinet 30 has been exemplified and illustrated as a wiredconnection to server 20, another embodiment of cabinet 30 may include awireless communication link between cabinet 30 and server 20.

Medicine Cart

As stated above, cabinet 30 is coupled to one or more medicine cart(s)50 through communication link 36. In a preferred embodiment, medicinecart 50, as exemplified and illustrated in FIG. 5, comprises a pluralityof compartments 51, 52, preferably in the form of drawers; a display ortouch screen 54; a cart processor (not shown), a communication link 55for linking to medicine cabinet 30; a keyboard 56, preferably a virtualkeyboard on touch screen 54; a bar code reader 57; and a communicationlink 53 to monitoring equipment. In a preferred embodiment, cart 50further comprises one or more chargeable batteries (not shown). In analternative embodiment of cart 50, the monitoring equipment is a part ofcart 50 or separate, but coupled to the cart processor through link 53.

The plurality of drawers 51, coupled to the cart processor, include adisplay screen 510, and are controllably locked by a locking and springmechanism (not shown), such as the lock and spring mechanism 32disclosed above and illustrated in FIG. 4. Each of drawers 51, 52 areadapted to receive medications for administration to patients. Asexemplified and illustrated in FIG. 5, cart 50 comprises drawers 52 ofdiffering sizes; the larger drawers 52 also being controllably locked bythe locking mechanism, which is controlled by the cart processor. Whilecart 50 is not coupled to medicine cabinet 30 and in an idle state,display 510 of each drawer 51 is blank indicating that each of drawers51 is unidentified, resulting in a generic medicine cart 50.

Preferably, cart 50 is in communication with server 20 throughcommunication link 55 coupled to medicine cabinet 30. As exemplified andillustrated in FIG. 5, communication link 55 is preferably positioned inthe lower rear portion of cart 50 in order to allow for the coupling ofmobile cart 50 to medicine cabinet 30. Although communication link 55 ispreferably located in the lower rear of cart 50, the communication link55 may be positioned any place on mobile cart 50, so long as the link isaccessible to medicine cabinet 30. Preferably, communication link 55 andcommunication 37 are coupled by a wire. In another embodiment, however,the coupling of communication links 55 and 37 is wireless, such as by aninfra-red (IR) or radio frequency (RF) connection. It should be notedthat communication link 37 of medicine cabinet 30 preferably includes acharger for charging the batteries (not shown) which operate cart 50when the cart is in use away from medicine cabinet 30.

When cart 50 is coupled to cabinet 30 at the initiation of rounds, thecart program assigns one or more specific drawer(s) to each patientreceiving medication during the rounds, resulting in the conversion ofcart 50 from a generic medicine cart to a patient specific cart. Foreach drawer assigned a specific patient, the patient's name is displayedon the patient specific drawer display 510. Once the healthcare providerhas finished the rounds, patient specific drawer display 510 for eachpatient is deleted, resulting in the return of cart 50 to a genericmedicine cart. More specific information regarding the administration ofmedication to patients is disclosed below.

The cart processor, is coupled to bar code reader 57, the plurality ofdrawers 51, 52, touch screen 54, communication link 55, keyboard 56, andcommunication link 53. The cart processor accesses the cart program inorder to operate cart 50 in accordance with a preferred embodiment. Forexample, the cart program assigns the drawers 51 to specific patients,controls the access to drawers 51, 52 and instructs the health careattendant in the filling of cart 50 and the administration ofmedications to the patients. Other functionality of cart 50 will bedisclosed below.

Information transmitted to medicine cabinet 30 from server 20 ispreferably transmitted to cart 50 through communication link 55. Thisinformation is utilized by the cart program to instruct the healthcareattendant in the administration of medications to the patients. Whileoperating cart 50, the healthcare attendant is preferably required tolog each event that is requested by the cart program and/or conducted bythe healthcare attendant, e.g., taking of the medication by the patient,refusal of medication by the patient, absence of the patient, and thelike.

Other information is also input to the cart program, such as real-timevital sign information. This information is taken by the healthcareattendant using the patient monitoring devices of cart 50, as disclosedabove. For those devices that are located at the patient's bedside,communication link 53 facilitates the communication between themonitoring devices and cart 50, such as through a standard RS-232 link.This information is later transmitted to server 20.

Bar code reader 57, coupled to the cart processor, is preferably used toidentify a patient, medication and dosage verification, and the like.When the healthcare attendant arrives at the patient's bedside, thehealthcare attendant preferably scans the patient's wristband. The timeat which this event takes place is preferably logged by the cart programand later transmitted to server 20.

Keyboard 56, which as indicated above is preferably a virtual keyboard,may be used as an alternative means of inputting patient information, aswell as for inputting information required by the cart program as itrelates to the administration of medication to the patient by theauthorized healthcare attendant. Keyboard 56 may also be used to inputany necessary identification means.

In an alternative embodiment, the cart program also controls thecharging of the one or more rechargeable batteries, such that, whencoupled to the medicine cabinet 30, the cart program determines whetherthe batteries need to be charged. If the remaining battery life of thebatteries is below a predetermined level, the cart program activates thecharging process. Otherwise, the cart program disengages the chargingprocess, enabling efficient use of the cart batteries.

As exemplified and illustrated in FIG. 5 and stated above, theinformation stored in the cart processor is transmitted to server 20through communication 55 to link 37 of cabinet 30. Similar to cabinet30, the information transmitted by cart 50 is processed by serverprocessor 23 and stored therein until database 22 retrieves theinformation therefrom. In another embodiment, the informationtransmitted from and transmitted to cart 50 is compatible with thatwhich is stored in database 22, wherein the information is directlytransmitted to, or transmitted from, database 22.

Although cart 50, in a preferred embodiment, is illustrated anddisclosed as communicating with server 20 through cabinet 30, in anotherembodiment, cart 50 may communicate directly with server 20 through adirect network connection or through a wireless IR or RF connection.Cart 50 may alternatively communicate with cabinet 30 through a wirelessIR or RF connection.

The preferred embodiment of cart 50 allows the healthcare attendant tolog real-time information related to drug administration at thepoint-of-care (i.e., at the patient's bedside), resulting in accurateand complete information.

Although cart 50 has been disclosed as communicating with server 20through cabinet 30, in an alternative embodiment, cart 50 communicatesdirectly with server 20 using a wired communication means on a wirelessIR or RF communication means.

Work station

Referring back to FIG. 1, one or more workstation(s) 70, coupled toserver 20 and hand-held Physician Order Entry (POE) computer 60,preferably accesses a workflow program that supports management andoperational functions including time related tasks, pharmacy andinventory control and intelligent decision capabilities to aid thephysicians and health care professionals. It should be noted that theterm “physician order entry” computer is generic and should not be usedto limit either the location of the computers or who may use thecomputer. The term “workstation” is also generic and means a singlecomputer at a single location, a plurality of computers at a pluralityof locations, and/or a plurality of computers at a single location.Accordingly, when the term workstation is used herein, it should not belimited to any one definition.

FIG. 2 is a block diagram illustrating the main components ofworkstation 70 as would be provided in a ward, group of wards, nursingstation(s), an office, and the like. Workstation 70 includes aconventional CPU (central processor unit) 71; an input 74 from handheldPOE computer 60 (FIG. 1); an input 79 from an I.D. badge or otheridentification reader; and one or more manual inputs 75, such as akeyboard, touch screen, mouse, and the like. The workstation processor71 includes an output a display 77 and a printer 78, e.g., for printinginventory records, patient medical records, physician orders, managementreports, etc. The workstation 70 preferably does not have a directoutput to cart 50 since it communicates with cart(s) 50 via server 20.Alternatively, however, when the functionality of server 20 resides on aworkstation 70, a direct link to cart(s) 50 may be provided, such asthrough a wired connection or wireless IR or RF connection.

A main task of the workflow program is to manage (open, update andstore) all patient entries for a respective ward, with every entrycomprising, for example, the following information for each respectivepatient: name; identification corresponding to a bar code printed on thewristband worn by the patient; referring and treating physicians;relatives; allergies; medication orders, including an electronicsignature or other electronic means by both the physician and/or theauthorizing pharmacist; the vital signs of the respective patient ascollected and stored during rounds, e.g., during a vital signs roundand/or medication dispensing round; information about all medicationsprescribed and delivered to the patient while he/she is in therespective ward; and additional information that may be required by aninstitution. These patient entries are preferably opened, updated andstored in a database, such as a Medication Administration Record (MAR)and Mini-Patient's Medical Record (MMR). The patient entry also includesa status flag indicating whether the respective entry is active ordeactivated (e.g., by the release or transfer of the patient to anotherward or by discharge of the patient). The MAR and MMR databasespreferably allow system 10 to access patients that have been dischargedfrom the institution. In a preferred embodiment, preferably thisinformation is retrieved from an Admission Dismissal Transfer (ADT)database, known in the art, located on the institution's legacy system.

When a patient is admitted, a healthcare attendant logs the patient'sname and information into the institution's legacy system. The patient'sinformation is then preferably transmitted to server database 22 forretrieval by the workflow program. Provided with the above information,as well as physician order entries for patients in the ward, theworkflow program actively schedules and alerts clinical staff regardingthe administration of medication, inconsistencies with data forprescriptions, and the like.

The workflow program allows an institution to set authorization levels.For example, an institution may implement a hierarchical authorizationscheme, wherein healthcare attendants are granted access to conductcertain tasks based in part on their level of experience, level ofemployment, and the like, e.g., a doctor may have access to prescriptionoperations, to work station 70, and medicine cabinet 30, whereas anentry-level nurse may only have access to medications in medicinecabinet 30 that are non-narcotic. The scheme and rules used by theworkflow program are determined by the institution. Alternatively, thescheme and rules may be embedded in the workflow program based onindustry standards or a medical institution's predetermined policy.

The workflow program also permits a hierarchical set up regardingindividuals with the authority to authorize others to have access tocertain components or operations within system 10, and therefore allowsinput by the individual with the authority to authorize. For example,the head nurse may have the authority to allow or deny access to anothernurse under his/her supervision. As above, this hierarchical scheme isdetermined by the medical institution's policy.

In accordance with a hospital's policies, work station 70, in variousembodiments using the workflow program, also manages on-demandmedications, such as stat medications, and PRN (per re nata), perrequest, medications. This necessitates opening certain drug specificdrawers, and permitting the immediate administration of medications to apatient, even though a prescription may not have been issued.Authorization for the dispensed on-demand and PRN medication issubsequently requested to provide the necessary record of the action. Asdisclosed above, when the medication is administered to the patient, thehealthcare attendant is preferably required to log the event and thereason therefor.

The workflow program also independently calculates and maintains arunning inventory of the contents of medicine cabinet 30, including, forexample, a special count for narcotic medications. Such inventories arecontinuously updated as the medications are dispensed and logged by thehealthcare attendant, and as the medications are replenished and logged.The workflow program also maintains a list of the different kinds ofmedications and their locations in the matrix of drawers in therespective cabinet. Workstation 70 also assists in stock management,allowing for the addition of a new medication to be dispensed, or theremoval of a medication no longer required. For example, computer 70manages “multiple use” medications, e.g., bottled medications, eyedrops, ointments, and the like, such that as the medications areassigned and used by a patient, computer 70 ensures that the properamount of medication is remaining for the patient's subsequent use, andwill notify the attendant accordingly.

Also, the workflow program assists in the maintenance of common stockmedications which may be assigned and administered to a patient. Asthose skilled in the art know, common stock medications are routinelymaintained in medicine cabinet 30 for administration to a patient.Common stock medications may include, but are not limited to, “multipleuse” medications, as well as over the counter drugs, such as eye dropsand bottled syrups. Accordingly, a common stock medication is assignedto a patient when authorized by someone authorized to prescribe suchmedication. For example, eye drops may be commonly stocked in medicinecabinet 30. When a patient is prescribed the eye drops, the workflowprogram transmits this information to the cabinet program which assignsthe eye drops to the patient and instructs the healthcare attendant toplace the eye drop container in the patient specific cabinet drawer 31,or instructs the attendant to bar code the eye drop container with thepatient's patient ID and leave the eye drops in the common stock drawer.

For first dose medications that fall outside of the regularadministration rounds or stat medication for a patient, theprescriptions for such medications may be filled at cabinet 30 throughworkstation 70. This eliminates problems associated with physicianstelephoning in prescriptions, with accurate maintenance of themedication inventory, and efficient time management, thereby getting themedication requested to the patient in a fast and safe manner.

The management of the expiration dates for medications stored inmedicine cabinet 30 is also done by the workflow program. Preferably,all medications stored in medicine cabinet 30 have been bar coded,scanned and stored by the workflow program, wherein the bar codeincludes, at least, the expiration date, batch number and name of themedication. Alternatively, the expiration date, name and batch number ofthe medication is inputted to the program manually using keyboard 75 aswill disclosed below. The workflow program, then, automatically checksthe expiration dates of all medications stored in medicine cabinet 30.An authorized healthcare attendant is warned through workstation 70 andan alert sounded at cabinet 30, when a medication is nearing theexpiration date.

The workflow program also produces, if so requested by an authorizedattendant, a wide variety of reports and records, including, but notlimited to: current inventories in each ward cabinet, e.g., graphicaldisplays of inventory levels, as well as the display of consumption ofeach drug over time and discrepancies in inventory count; thereplenishing level of each medication; information concerning patientfiles, individually and collectively; information concerning patientvital signs, e.g., for graphic display; information regarding alldispensing and replenishing of medications from the medicine cabinets,including date, time, names, and the like; replenishing forms to bedirected to the pharmacy for replenishing a medication (a task which canalso be performed by linking to the pharmacy computer); forms foremergency medication; and summaries of all the medications received by aparticular patient during the stay in the respective ward, includingbilling, etc. This capability of the workflow program further supportspatient accounting and reimbursement.

As indicated above, the workflow program provides, for example, theinventory of medications and their locations in cabinet 30, the names ofthe patients and their prescribed medication dosages; the type andquantities of medications as dispensed and as replenished; and the vitalsigns data with respect to the patients, each of which is inputtedmanually during a routine check by a nurse or other health carepractitioner, such as physical therapists, inhalation therapists,radiologists and the like, or by a pre-authorized individual dispensinga medication to the patient.

It should be noted that a medical institution may utilize more than onework station 70, wherein each workstation 70 is coupled to server 20 andprovides authorized users with access to the workflow program. When aplurality of workstations 70 exist, they may be located in one area orspread throughout the medical institution. For example, a work station70 may be located at a nursing station in the maternity ward, as well asin the office of the head nurse of the same ward, or each nursingstation in each ward of an institution may include a work station 70,etc. Nevertheless, for the purposes of this disclosure, if a pluralityof workstations are used, they will be referred to herein simply as“work station,” so long as each of the plurality is linked. Hospitalpolicy preferably dictates how many work stations 70 are included insystem 10, who is authorized to access the work station 70, and his/herlevel of access to the information provided therein.

POE Computer

A system for the safe and efficient administration of medicationrequires a computerized patient file containing, at least, the detailsof the patient and the medication the patient is to receive. This datamay be hand-entered in the server 20 through work station 70, fromhand-written notes, e.g., prepared at the time of the physician rounds.However, in a preferred alternative a hand-held POE computer 60, isillustrated in FIG. 6, which includes prescription software to allow thephysician to prescribe medications at the point of care (i.e., at thepatient's bedside).

As indicated above, POE computer 60 is preferably coupled to workstation70. POE computer 60 includes a large display 62, preferably of the touchscreen type to enable inputting information, and a communication link63, which may be wired or wireless, to establish communication withserver 20. In an alternative embodiment, hand held POE computer 60further comprises a bar code scanner, for identifying a patient to beexamined. Such POE computer 60 executes a prescription program thatallows the physician to prescribe medications through the system, orchange the medications or their dosages, and check drug interactions andpatient allergies at the time of prescribing. Preferably, a commercialproduct, such as First Data, is utilized to verify drug interactionsafter a medication is prescribed by the physician for a patient. Thevalidation program informs the physician regarding any negativeinteractions. The prescription program also facilitates the receipt andretention of the physician's, and/or the pharmacist's electronicsignature or other electronic identifying means, together with the restof the data collected.

The prescription program alternatively allows the institution, inaccordance with the institution's policies, to limit the physician'sability to prescribe certain medications. The limitations may be basedon the economics of dispensing a certain medication as compared to asimilar medication, or inventory in the institution, for example. It ispreferable for this alternative to allow the physician to override thelimitations by the institution when he/she see fit, as long as thephysician explains the reason for the override, which explanation isprompted by the prescription program. The prescription program will timeand date stamps the explanation and store this information.

At the end of the rounds, the hand-held POE computer 60 may be coupledto work station 70 through input 24 to permit the transmission of all ofthe information collected in the hand-held POE computer 60, includingthe electronic signature or other electronic identifying means of thephysician and/or pharmacist. This information is entered into the recordof each respective patient by the prescription program. Hand-held POEcomputer 60 may also be used for entering and/or displaying patientspecific information, for example, the vital signs, sensitivities, druginteractions and any other pertinent data taken while the patient ishospitalized.

Hand-held POE computer 60 and its ability to link to the programsignificantly reduces human error due to transcription and poorlegibility, and helps reduce insurance and liability costs to thephysician and institution.

In an alternative embodiment, the functionality of each componentprogram may be accessed by any other system 10 component. For example,the workflow program may be accessed by medicine cabinet 30 or POEcomputer 60. When the scheduler of the workflow program alerts medicinecabinet 30 of the start of a round, medicine cabinet 30 accesses thecabinet program and the workflow program.

Although system 10 has been disclosed in accordance with a preferredembodiment illustrated in FIG. 1, any one of the components of system 10may communicate directly with any other component by wirelesscommunication such as RF or IR communication means, wherein eachcomponents comprises a means of communicating in a wireless environment.

Operation

The described system 10 may be used in performing a number of processesincluding, but not limited to the following:

Initial Data Entry

As indicated above, each of the disclosed components is coupled to wardcomputer 20, providing a closed loop computerized work flow system whichmanages the patient care including, for example, including, for example,prescribing to the dispensation, administration and reporting ofactivities.

When a patient enters the medical institution (i.e., for admission tothe extent that drugs or medications will be administered to thepatient), patient information is preferably entered into theinstitution's legacy system by an authorized healthcare attendant or viainterfacing with patient information already stored in a centraladmissions system, such as the ADT described hereinabove. Theinstitution legacy system transmits the ADT information for the admittedpatient to system 10. The patient information includes demographicinformation, which is then included in a patient file. Once the patientfile is opened, a bar code is preferably generated using theinstitution's patient ID, generated by the legacy system duringadmission, or using a patient ID generated by system 10, which isindicative of a patient code that is associated with the patient. Aprint signal is preferably sent to a printer (not shown). The printedbar code is then preferably placed on a wrist band that the patientwears on his/her wrist until discharge from the ward. This patient codeis preferably used as the means of ensuring the accuracy of theidentification of the patient by any of the healthcare professionals.

A treating or attending physician on rounds, for example, preferablyuses POE computer 60 as disclosed above to review the informationtherein in order to evaluate a patient's current condition. For example,when the physician arrives at the patient's bedside, the physician logsonto the POE computer 60 by entering in his/her authorizationinformation using an identifying means disclosed above. An exemplaryframe of the handheld POE computer 60 for entering the physician'sauthorization information is illustrated in FIG. 7. Once the physicianhas logged onto handheld POE computer 60, a list of patients isdisplayed by room number, in alphabetical order, or those patientsattended to by the physician, for example, as exemplified in FIG. 8. Thephysician then chooses the patient's name of the patient he/she isattending or scans the patient's wrist band, automatically selecting thepatient. The selection of the patient's name results in a display of thevitals and information for that patient, which have been previouslyinput by an authorized attendant or physician. An illustration of anexemplary frame showing graphical and tabular vital information is shownin FIGS. 9 and 10. Each of these exemplary frames also comprisesmultiple keys or tabs.

As exemplified in FIG. 10, the physician may then choose to review thepatient's current prescriptions and his/her respective details byselecting the RX tab. The physician may also choose to view the clinicaldata and instructions by selecting the appropriate tab on the screen,which displays that information, for example, the patient's allergiesand symptoms.

The physician is able to find and prescribe new medications for thepatient using the RX tab as illustrated in FIG. 12. As stated, aphysician is able to review the medications a patient is currentlytaking by selecting the RX tab which frame exemplified in FIG. 9. Oncein the RX tab, the physician is able to view the details for eachprescribed medication. This tab also provides the physician with a meansof prescribing a new medication.

To prescribe a new medication, the physician first selects the “new”button included in the exemplary RX frame. As a result, for example, anAdd New medication frame is displayed, such as that which is illustratedin FIG. 12. Although not shown in FIG. 12, a physician may choosemedications from multiple listings. For instance, illustrated in FIG. 12is a list of generic medications that are located within the hospitalthat the physician may choose from if the patient is required to havegeneric medications due to insurance restrictions, if the patientrequests generic medication to be used, or if a physician requests ageneric medication in accordance with hospital policy. The physician,though, may choose to prescribe brand name medication that is equivalentto the generic drug, in which case, the physician may select the“Commercial Names” tab to view a list of brand name medications. Forthose medications that are rarely prescribed, the physician may selectfrom a national database that includes all medications available forprescribing, such selected medications would then have to be ordered.For those medications located in the inventory of the hospital, thephysician is able to filter a list based on the location of themedication, e.g., ward or pharmacy, whether it is a special medicationor an order set. Although the medications have been listed by name, itshould be noted that the medications can be listed by system, e.g.,nervous system, respiratory system, etc.

As described above, the POE computer 60 allows the physician toprescribe medication in accordance with a hospital policy that has beenset up to ensure that the prescribed medication is the best medicationfor the patient and most economical for the hospital. Accordingly, thePOE computer 60 preferably provides the physician with the recommendedmedication to be prescribed in response to the physician's selection. Ifpermitted by the hospital, a physician may override the recommendationof computer 60, and prescribe the physician selected medication. If thephysician is unable to override computer's 60 recommended medication,the recommended medication is prescribed.

Once the physician has selected the medication, the physician preferablymust enter the details of the order of the administration of themedication, such as dose, duration, schedule and frequency, as well asother pertinent information that will be used by the authorizedhealthcare attendant. The physician may also use defaults that are setby the hospital, which include the medication dose, duration, scheduleand frequency. Also, treatment protocols may be prescribed by thephysician, which may comprise several different medications and otherorders, such as fasting, and the like. For example, after hip surgery, apatient may receive a predetermined medication and diet regimen that isused for most hip surgery patients. An example of the frame for enteringthe details of the newly prescribed medication is illustrated in FIG.13.

Once the physician has completed the examination of the patient andprescribed the necessary medications, the physician may then exit theAdd Medication frame. Upon exiting, POE computer 60 conducts a clinicalscreening of the medications prescribed for the patient and verifiesthat there are no known negative interactions between medications andthat there are no known negative interactions between the medication andthe patient's allergies or safety concerns. A typical and commonly usedand accepted database for such procedure is, for example, First DataBank or Micro Medics. The order entered by the physician is thenautomatically compared against predetermined standards to assure thatthe dosage is correct, and undergoes screening against the patient'smedical history, including drug allergies and multiple druginteractions. It should be noted that the physician may look up the druginteraction, and side effect while prescribing medications by selectingthis option on POE computer 60. Nevertheless, even if this option isselected by the physician, a check is automatically conducted afterprescribing all medications for the patient.

A confirmation screen is then displayed to confirm the physician'sorders. An exemplary confirmation screen is illustrated in FIG. 14.Preferably, the physician must then confirm the orders that have beenentered for the patient by selecting the ‘Yes’ button, which results inthe display of another confirmation screen, thereby further eliminatinga point of error. The physician is then asked to input his/heridentification means, which causes handheld POE computer 60 to generatethe physician's electronic signature, or other electronic identifyingmeans, verifying that the physician is authorized to make such aprescription. The physician may then continue with rounds, visiting thenext patient and repeating the process as necessary. Once thephysician's rounds have been completed, the physician preferablyattaches handheld POE computer 60 to input 24 (i.e., a docking station)coupled to work station 70. Work station 70 transmits the informationinput by the physician to server 20. Once the information is transmittedto server 20, all information is preferably deleted from handheld POEcomputer 60, which protects the information from being accessed byunauthorized individuals who may, without authorization, access POEcomputer 60. When POE computer 60 is to be used by a physician,information for each patient in the ward is preferably transmitted byPOE computer 60.

In an alternative embodiment, and in accordance with governing law, anynew prescription information that is transmitted to the pharmacycomputer for clinical screening by an authorized pharmacist. Thepharmacist reviews the medications prescribed and the patientinformation, and verifies that no negative implications would resulttherefrom. Also, the pharmacist confirms that the dosage of prescribedmedicine is valid for the patient receiving it. If the pharmacist doesnot confirm the prescription, the prescribing physician is contacted.This is preferably accomplished by interfacing with pre-existingpharmacy software on the pharmacy computer. Alternatively, this is doneby providing the pharmacy with a work station that accesses the workflowprogram, or by providing the pharmacy computer with access to theworkflow program.

In a wireless setting, the physician orders may be transmitted by thephysician to the pharmacy computer and the workflow program. In aalternative embodiment, the prescribing program may be accessed from aremote location, such as the Internet and the like.

When the new orders arrive at workstation 70 the attendant is alerted bythe workflow program to verify the new orders. Each attendant verifieshis/her patients' new instructions by reading them and deploying them tothe rounds times according to the frequency ordered by the physician.The workflow program in response to the deployment of all the neworders, along with the already existing orders, creates a scheduler forthe ward for the day, and for the following days. The scheduler displaysall orders to be performed according to the time at which they are to beperformed. The orders may also be displayed by patient and his/herorders are spread over the prescheduled time(s) for administration. Itis this scheduler which alerts the attendant to start a medication roundor vital sign collection round, or administer a specific medication toone patient, to be disclosed below.

Preparing Dosages

At the prescheduled time for dispensing medications, or when thedispensing of medication is otherwise needed, work station 70 preferablyalerts a healthcare attendant using display 77. In a preferredoperation, work station 70 transmits to cabinet 30 the list of patientsto receive medication at that time, and when required, it identifieseach patient, the medication, and the dosage for that patient. The alertcontinues until the authorized attendant selects the task for which thealert was sent.

Once medicine cabinet 30 has received the information from the workflowprogram, touch screen 34 displays a medication preparation screen, suchas that which is exemplified in FIG. 15. Preferably, the healthcareattendant assigned to administer medications to the patients in the wardassociated with medicine cabinet 30 must identify himself or herself inorder to access medicine cabinet 30 using an identification means, suchas a password code, a personal identification means or a biometricidentification means. Preferably, this information is input usingcabinet touch screen 34. When the correct identification information hasbeen entered, medicine cabinet 30 may be accessed by the authorizedattendant.

As disclosed hereinabove, an authorized healthcare attendant administersscheduled medications to the plurality of patients in the ward usingmobile cart 50. Accordingly, it is preferable that cart 50 be coupledto, and in communication with, cabinet 30 through communication link 37of cabinet 30 and communication link 55 of cart 50.

Once server 20 has verified the attendant's authorization information,the cabinet program initializes the instructions for the attendant tofill cart 50 for administration of medications to the respective wardpatients. Since a ward may have more than one medication cart 50available for administering medications, the authorized healthcareattendant is asked to select and identify the medication cart that is tobe filled.

Once the attendant has selected the cart to be used during the rounds, apatient is chosen from the list of patients in the ward that are toreceive medication and the chosen patient's name, ID and medications tobe administered is displayed on display 34, as exemplified in FIG. 16.To ensure that in each case the correct medication is administered tothe appropriate patient in the right amount, the cabinet programdisplays instructions that the healthcare attendant is to follow onscreen 34 of cabinet 30 in filling cart 50. Cabinet processor 38controls the healthcare attendant's access to the medication in therespective medication specific drawers 31 of cabinet 30 and access todrawers 51 of cart 50 via the cabinet program. Accordingly, once thepatient has been selected, the medication to be dispensed is thenselected and the healthcare attendant instructed on dispensing themedication into cart 50. An exemplary illustration of the selection ofthe medication and the instructions related thereto is shown in FIG. 17.

Processor 38 forwards the selected patient to cart processor 52, whichassigns a specific drawer 51 of medication cart 50 for the selectedpatient and displays the name of the patient assigned to the assigneddrawer 51 on display 510 of the selected drawer 51. The assignment ofthe drawer by cart processor 52 changes the identification of cart 50from an unidentified cart to a dispensing cart comprising a plurality ofpatient specific drawers.

After patient specific drawer 51 has been assigned by cart processor 52,processor 38 forwards an open drawer signal simultaneously to both acabinet medication specific drawer 31 and cart processor 52. Themedication specific drawer 31, which has the selected medication storedtherein, receives the open signal and unlocks and springs forward themedication specific drawer 31, all other drawers of cabinet 30preferably remain locked and closed. Simultaneous to the opening ofmedication specific drawer 31 of cabinet 30, cart processor 52 receivesthe open signal from cabinet processor 38, sends an open drawer signalto the patient specific drawer 51 assigned to the selected patient,causing patient specific drawer 51 to unlock and spring forward, allother drawers of cart 50 remaining locked and in a closed position.

In at least one embodiment, the authorized healthcare attendant, havingopened medication specific drawer 31 and patient specific drawer 51open, follows the directions displayed on display 34 of cabinet 30 tofill open patient specific drawer 51. For example, in practice, theattendant takes the appropriate dose of a medication from an openmedication specific drawer 31 of cabinet 30 and preferably scans the barcode label of the medication. This verifies that the correct medicationhas been retrieved from cabinet 30. Alternatively, and preferably inaddition, the attendant verifies the medication visually. When thecorrect medication has been retrieved, the medicine is placed in openpatient specific drawer 51 of cart 50. Following the instructionsdisplayed, the attendant then closes medication specific drawer 31 ofcabinet 30.

Processor 38 of cabinet 30 detects the closing of medication specificdrawer 31. If there is another medication that is to be dispensed to theselected patient, cabinet processor 38 identifies the next medicationfor the selected patient, and forwards another open drawer signal to themedication specific drawer that has the selected medication storedtherein. Again, a medication specific drawer of cabinet 30 receives thesignal from the cabinet processor 38, unlocking and causing the drawerto spring forward. The attendant repeats the steps disclosed above forremoving the medication from cabinet 30 and places the appropriateamount of the identified medication in already open patient specificdrawer 51 of cart 50, as disclosed above.

The foregoing process continues until all specified medication for therespective patient has been removed from the cabinet 30 and placed intothe patient's patient specific drawer 51. It should be noted that themedication selected by cabinet processor 38 may be stored in a patientspecific drawer of cabinet 30. Accordingly, cabinet processor 38forwards an open signal to the patient specific drawer located incabinet 30 assigned to the selected patient, which is then opened. Asdisclosed above, the cabinet patient specific drawer is used to storemedications that are not generally stored in the medication specificdrawers of cabinet 30. Special medications, stored in the specialcompartments of cabinet 30, are also dispensed to the patient specificdrawers of cart 50 in the manner disclosed above. If narcotics are to beadministered, the attendant is preferably required to re-enter his/heridentification means. It should be noted that requirements foradministering narcotics are dependant on the medical institution'spolicies or governmental requirements. For those medications, if any,that cannot fit within the open patient specific drawer 51, theattendant is instructed to bar code the medications and place themedication into cart drawer 52. These medications are preferably labeledwith the patient ID barcode for positive identification duringadministration of the medication.

Once all of the medications for the selected patient have been placed inopen cart drawer 51, 52, cabinet processor 38 then instructs theattendant to close the open patient specific drawer 51. The system thenrepeats the foregoing operations with respect to all of the otherpatients list, to receive medications at that time each patient beingassigned a separate drawer in cart 50 and his/her respective medicationsplaced therein. Each patient specific drawer displays the name of therespective patient assigned to the drawer on the display of therespective drawer as disclosed above.

At any time during this process, if the prescribed medication is notavailable in cabinet 30, cabinet 30 guides the authorized attendant viaits display to order the medication from the central pharmacy; at thesame time, work station 70 issues an order form to the central pharmacy,or otherwise orders the appropriate medication through its communicationwith the central pharmacy.

In a centralized system comprising a central pharmacy, medicine cabinet30 is utilized to store unit dose medications for each patient, the unitdose for a 24 hours period. Patient specific drawers 31 of cabinet 30are assigned to each patient wherein the unit dose medications for eachpatient are stored and accessed to fill cart 50 each round. The patientspecific drawers are then replenished at the end of the 24 hour periodwith the unit dose medications for the next 24 hour period. If there arechanges to the orders or new PRN or stat medication, the requestedmedication is dispensed from the medication specific drawers 31 ofcabinet 30.

Although it is preferable that cart 50 is filled before each round andemptied after each round, cart 50 is alternatively filled with 24 hoursof patient medications and used for each round within the 24 hours. Cartprocessor 52 assigns the cart patient specific drawer 51 to each patientin the respective ward once every 24 hours. Patients that are admittedto the ward during the 24 hour period are also assigned to a patientspecific drawer by cart processor 52.

Alternatively, cart processor 50 assigns a patient specific drawer toeach patient, wherein the assigned drawer remains assigned to thepatient until the patient is transferred from the ward associated withthe cart or discharged from the institution. Accordingly, after the allmedications for the 24 hour period have been administered to thepatients assigned to cart 50, containers including each patient'smedications for the next 24 hours is used to refill each patientspecific drawer. The manner upon which each drawer is filled is similarto the method disclosed above regarding the filling of the cart frommedications stored in the medicine cabinet. Display 54 of cart 50,displays, for example, the patient's name, allergies, medications,dosages and instructions on filling the patient's drawer.

Delivery of Medications to the Patients

After cart 50 has been filled for each patient receiving medication, theauthorized healthcare attendant wheels cart 50 to the patients in theward for administration of their respective medications. The attendantpreferably delivers the medications to the patients in the followingmanner for each:

When the attendant arrives with cart 50 at the patient's bedside, theattendant preferably uses bar code reader 57 to scan the patient'swristband. Cart processor 52 detects the patient code input by bar codereader 57, compares the received code to the patient codes storedtherein, associates the code with a patient, and causes the patient'sspecific drawer 51 to be unlocked and pushed forward, wherein the otherdrawers of cart 50 remain locked and in the closed position. Thepatient's name is also displayed on screen 54 together with the list ofmedications contained within the respective patient specific drawer 51,the total number of medications in drawer 51, and the list of vitalsigns to be obtained by the attendant, for example, other patientspecific information, e.g., age, weight, allergies, etc. If a prescribedmedication was not been available from medicine cabinet 30, andtherefore, had been ordered directly from, the central pharmacy asdescribed above, cart display 54 would include a reminder of this factto the attendant.

The attendant then counts the total number of medications in the openpatient specific drawer 51, and matches the total number counted withthe total number of medications shown on display 54. Assuming a matchoccurs in all respects, the attendant then administers the medication tothe patient. Alternatively, the attendant may scan each medication inthe patient drawers to verify that the patient is receiving the correctmedication. For those medications taken from the common drawer 52, themedications must be scanned for verification.

In an alternative embodiment, cart display 54 displays a list ofpatients that are to receive medications during the current round. Whenthe attendant arrives at a patient's bedside, the attendant would verifythe identification of the patient and select the patient's name from thelist of patients displayed on display 54. Once the patient is selected,cart processor 52 operates in the manner set forth above in thepreferred embodiment.

During the administration of the medications, the attendant isinstructed by cart 50. For each medication to be administered, cart 50preferably provides step by step instructions. When an IV isadministered, the attendant is preferably instructed to check andconfirm the flow rate. The attendant is also instructed on which hand orarm the IV or injection should be used, depending on the previous placeof administration. Preferably, each time a medication is taken by thepatient, the attendant is required by cart 50 to confirm and log thisevent. If a medication is not taken by a patient, cart 50 preferablyrequires the attendant to log the reason the medication was notadministered. This is also required of the attendant if during the rounda patient is not in his/her bed. In this case, the attendant would logthat the patient was skipped and the reason therefor. As disclosedabove, the logging of these events are transmitted to server 20.

If certain vital signs are to be taken of the patient (e.g.,temperature, blood pressure, pulse rate, etc.), as instructed via cartdisplay screen 54, the attendant attends to the gathering of thisinformation and inputs the information via cart connector 58 or manuallyvia keyboard 56. The gathering of this information is also logged andstored in cart 50 until cart 50 is coupled to cabinet 30 fortransmitting said information to server 20.

For those cases where the medication administration is conditioned bycertain data (i.e., vital sign result or lab result), then the attendantis instructed to check the condition and enter the value forconfirmation. If the value allows for the administration of themedication, the attendant will be advised to do so.

Replenishing the Medicine cabinet

As disclosed above, the workflow program maintains the inventory ofmedicine cabinet 30 associated therewith. Accordingly, whenever theworkflow program detects a “low level” of medication in one of drawers31, this fact is displayed for the responsible healthcare attendant ondisplay 74 and automatically ordered from the pharmacy via forms, or viaa communication channel between the pharmacy computer and the workflowprogram. Alternatively, the workflow program may request the authorizedattendant to reorder the identified medication from the pharmacy.

Work station 70 may be requested at any time to authorize areplenishment from the central pharmacy. If the ordering is done withforms (i.e., without direct communication), the workflow program ispreferably supplied with a list of medications received from thepharmacy, including the exact amount of every new medication. Theworkflow program updates the inventory and transmits this information tomedicine cabinet 30. For each such medication, the cabinet programinstructs the attendant to perform the following operations:

The attendant opens the packaging of the medication, counts the units,records the count and places the medication in the open drawer. At thistime, the attendant again must match the name on the package with thename on the front of the open drawer. For further safety, the attendantmay be required to scan the bar code on the medication packaging usingcabinet bar code reader 131 to match it with the name of the medicationdisplayed on cabinet screen 34.

The attendant then closes the medication specific drawer. When theclosed drawer is sensed by medicine cabinet 30, cabinet processor 38repeats the foregoing cycle for all the remaining medications on thelist for replenishment until all medications are replenished. If duringsuch a replenishing operation the attendant notes that one of thedrawers is full, the attendant may press a “fill” button on cabinetkeyboard 33 (or on display 34, if a touch screen is used), whereuponcabinet processor 33 will open an empty drawer, print a label with thename of the medication, and instruct the attendant to place the label onthe new open drawer. Thus, a second medication specific drawer iscreated for the patient.

It should be noted that a cabinet patient specific drawer is filled andreplenished in the same manner as disclosed hereinabove. When cabinetprocessor 38 determines that a patient specific drawer should beutilized for the received medication, a cabinet drawer assigned to thepatient associated with the received medication is opened and themedication placed therein. If no cabinet drawer has been assigned to thepatient, processor 38 opens an empty drawer not currently in use, anddisplays the patient's name on the cabinet drawer LCD display. Theattendant is the instructed to place the received medication in thepatient specific drawer.

Once all of the medications have been placed in their respectivemedication or patient specific drawers, the workflow program comparesthe count values and information regarding each medication as input bythe attendant to the count and information received by the pharmacy andidentifies any discrepancies.

It is appreciated that certain features of the invention, which are, forclarity, described in the context of separate embodiments, may also beprovided in combination in a single embodiment. Conversely, variousfeatures of the invention, which are, for brevity, described in thecontext of a single embodiment, may also be provided separately or inany suitable subcombination.

Although the invention has been described in conjunction with specificembodiments thereof, it is evident that many alternatives, modificationsand variations will be apparent to those skilled in the art.Accordingly, it is intended to embrace all such alternatives,modifications and variations that fall within the spirit and broad scopeof the appended claims. All publications, patents and patentapplications mentioned in this specification are herein incorporated intheir entirety by reference into the specification, to the same extentas if each individual publication, patent or patent application wasspecifically and individually indicated to be incorporated herein byreference. In addition, citation or identification of any reference inthis application shall not be construed as an admission that suchreference is available as prior art to the present invention.

1-25. (canceled)
 26. A method for administering one or more medicationsto each of a plurality of patients comprising the steps of: generating ascheduler, using a workflow program, which coordinates theadministration of medications to each patient; providing patientspecific information to a medicine cabinet, controlled by a cabinetprogram, which cabinet stores the medications therein; dispensing themedications to a medicine cart by an authorized user in response to saidscheduler and said patient specific information; assigning each patientone or more cart drawers upon the cart receiving said patientinformation, wherein each assigned cart drawer becomes patient specific;controlling access to the medications in the patient specific cartdrawer by a cart program; and administering the medications to eachpatient from the patient specific cart drawer.
 27. The method of claim26, further comprising designating in said medicine cabinet one or moreof a plurality of cabinet drawers, as medication specific.
 28. Themethod of claim 26, further comprising generating a physician order foreach patient, wherein said physician order is included in said patientspecific information.
 29. The method of claim 27, further comprisingsimultaneously granting access to a medication specific cabinet drawerand medications included therein and said patient specific cart drawerto the authorized user, by said cabinet program and said cart program,respectively, while each of the remaining plurality of cabinet and cartdrawers are inaccessible to the authorized user.
 30. The method of claim29, further comprising granting access to another one of the pluralityof cabinet drawers and medications included therein, wherein said accessis granted to the authorized user, one cabinet drawer at a time, whenthe cabinet program detects closure of a previously accessible cabinetdrawer.
 31. The method of claim 30, further comprising closing saidpatient specific cart drawer upon detection by said cabinet program thatall patient medications for that patient have been dispensed.
 32. Themethod of claim 26, further comprising designating said one or morecabinet drawers as patient specific, each one or more patient specificcabinet drawers being assigned by the cabinet program to a patient. 33.The method of claim 26, further comprising reading a patientidentification to verify that the correct patient is being administeredmedication using a bar code reader.
 34. The method of claim 26, furthercomprising: designating one or more drawers in the cart as a commondrawer; bar coding said medications in said common drawer with a patientidentification for whom the medication is ordered; and reading said barcoded medication in said common drawer to confirm the correct medicationis administered to the patient.
 35. The method of claim 26, furthercomprising logging administration information for each patient receivingmedication.
 36. The method of claim 26, further comprising: taking vitalsign information of a patient in accordance with the patient specificinformation using monitoring equipment; and transmitting said vital signinformation to said workflow program.
 37. The method of claim 26,further comprising: calculating a running inventory of the medicationsin each of the cabinet drawers; and updating said inventory as themedications are dispensed or replenished by an authorized user.
 38. Themethod of claim 26, further comprising reading a bar coded medication toverify that the medication is dispensed correctly.
 39. A system fordispensing medications and medical supplies to patients, said systemcomprising: a central cabinet in which said medications and supplies maybe stored, and from which said medications and supplies may bedispensed; one or more mobile dispensing carts which may transport saidmedications and supplies to each patient, each cart comprising one ormore drawers, wherein each drawer is associated with an individualpatient and contains said medications or supplies which are to bedispensed to said individual patient; and a control system by which saidcabinet and each said cart may exchange one or more of patientidentification data, medications or supplies to be distributed to eachsaid patient, times said medications or supplies are to be administeredto each said patient, times at which said medications or supplies aredispensed to each said patient, and said drawer in which each saidpatient's medications or supplies are located.
 40. The system of claim39, further comprising a drawer identification system, saididentification system comprising an indicator associated with each saiddrawer, wherein said indicator indicates said identity of said patientto which said medications or supplies in each said drawer are intendedto be dispensed.
 41. The system of claim 40, wherein when said identityof each said patient is associated with each said drawer by said controlsystem.
 42. The system of claim 40, wherein one or more of said drawersfurther comprise at least one of said indicators.
 43. The system ofclaim 39, wherein one or more of said drawers further comprises alocking system.
 44. The system of claim 39, wherein said one or more ofsaid drawers may be selectively locked and unlocked.
 45. The system ofclaim 44, wherein said locking system is actuated by said controlsystem.
 46. The system of claim 39, wherein said control systemmaintains an inventory of said mediations or supplies contained in saidcentral cabinet.
 47. The system of claim 39, wherein said control systemmaintains an accounting of said drawers from which said medications andsupplies have been dispensed.
 48. The system of claim 39, wherein saidcontrol system maintains an accounting of times at which said drawershave been opened or closed.
 49. A delivery device for a medicationdispensing system, said delivery device comprising: a plurality ofsections for receiving medication dosages prescribed for named patients;and a central display central display screen for displaying the patientnames and their respective medication dosages.
 50. The delivery deviceaccording to claim 49, wherein the delivery device is a mobile cart, andsaid plurality of sections comprise a plurality of drawers for receivinga plurality of medication dosages prescribed for named patients; each ofsaid drawers including a display screen.
 51. The delivery deviceaccording to claim 50, wherein said delivery device further includes areader device for reading an identification of a named patient to enablematching the read identification with an identification of a namedpatient to receive a prescribed medication dosage communicated to thedelivery device.
 52. The delivery device according to claim 51, whereinsaid delivery device includes an input device for inputting dataregarding vital signs of a respective patient.
 53. A medicine cabinetfor a medication dispensing system, said medicine cabinet comprising: ahousing including a plurality of compartments for containing supplies ofdifferent kinds of medications to be accessed by a health care attendantfor preparing individual medication dosages for named patients; aprocessor having a memory for storing the names of patients and theirprescribed medication dosages; and a display screen for displaying saidpatient names and their respective prescribed medication dosages. 54.The medicine cabinet according to claim 53, wherein said medicinecabinet further includes a plurality of light indicators, one for eachof said compartments controlled by said processor, to indicate thecompartment containing the medication supply to be included in aprescribed medication dosage for a named patient.
 55. The medicinecabinet according to claim 53, wherein said compartments are in the formof drawers which are normally locked but which are selectively unlockedby said processor when containing a medication supply to be included ina prescribed medication dosage for a named patient.
 56. The medicinecabinet according to claim 53, wherein said medicine cabinet furtherincludes a label printer for printing the names of new medications to beapplied to empty compartments to receive supplies of the newmedications.
 57. The medicine cabinet according to claim 53, whereinsaid processor further stores in its memory a running inventory of eachmedication supply in each compartment including all quantities suppliedless all dosages removed.